NON SURGICAL TREATMENT

Caudal Steroid Injection
A caudal steroid injection is used to treat pain in the lower back and leg. Swelling and inflammation are common causes of pain that can be reduced with steroids. Steroids can be administered by a simple injection, and monitored with fluorescent dyes to ensure that the medication reaches the inflamed tissue.

Conditions
  • Spinal stenosis
  • Foraminal stenosis
  • Cervical radiculopathy (Pinched Nerve)
  • Lumbar radiculopathy (Sciatica)
  • Herniated disc
  • Bulging disc
  • Torn disc
  • Facet Joint Syndrome
  • Arthritis
Treatment
  • A physician injects fluorescent dyes that create contrast in the tissue indicating painful areas
  • A combination of local anesthetic and anti-inflammatory steroids is injected into the area experiencing pain
  • Injections are repeated as needed
  • Reduced swelling and inflammation will lessen pain
Cervical Epidural Steroid Injection
The cervical region of the spine is the neck. A membrane called the dura covers the spine and nerves in the cervical region. The space directly surrounding the dura membrane is called the epidural space. Nerves travel in and out of the epidural space to reach other parts of the neck, the shoulders, and arms. When these nerves become inflamed a patient may experience pain. An epidural injection uses anti-inflammatory steroids to reduce nerve swelling in the epidural space and subsequent pain.

Conditions
  • Herniated disc
  • Bulging disc
  • Torn disc
  • Degenerative disc disease
  • Arthritis
  • Cervical radiculopathy (Pinched Nerve)
Treatment
  • Using x-ray guidance a small needle is inserted into the epidural space
  • Fluorescent dye is injected to provide contrast and show the inflamed areas
  • Anti-inflammatory steroids and a local anesthetic are then injected into the epidural space
  • Treatment can provide permanent relief or temporary relief while the damage heals
Lumbar Epidural Steroid Injection
The lumbar region of the spine is the lower back. A membrane called the dura covers the spine and nerves in the cervical region. The space directly surrounding the dura membrane is called the epidural space. Nerves travel in and out of the epidural space to reach other parts of the neck, the shoulders, and arms. When these nerves become inflamed a patient may experience pain. An epidural injection uses anti-inflammatory steroids to reduce nerve swelling in the epidural space and subsequent pain.

Conditions
  • Herniated disc
  • Bulging disc
  • Torn disc
  • Degenerative disc disease
  • Arthritis
  • Cervical radiculopathy (Pinched Nerve)
Treatment
  • Using x-ray guidance a small needle is inserted into the epidural space
  • Fluorescent dye is injected to provide contrast and show the inflamed areas
  • Anti-inflammatory steroids and a local anesthetic are then injected into the epidural space
  • Treatment can provide permanent relief or temporary relief while the damage heals
Discography
Spinal discography can be used to diagnose and treat pain associated with damage to the intravertebral discs, the soft jelly-like cushions located between the vertebrae in the spine. Spinal discography is an injection of fluorescent dyes that provide contrast to the damaged tissue and help physician's locate the problem. A physician can use this procedure to establish which discs are damaged and which are healthy, and whether or not the patient's pain is related to disc disease.

Conditions
  • Arthritis
  • Herniated disc
  • Bulging disc
  • Torn disc
  • Degenerative disc disease
Treatment
  • Using x-ray guidance a small needle will be inserted into the center of the disc
  • Contrast dye will be injected into the discs
  • Patients are then asked to describe if the contrast dye causes any pain
  • Evaluation of the pain levels with the contrast will show if the disc is the source of pain
  • The visual provided by the contrast dye will enable physicians to see disc damage
Facet Joint Injection
Two facet joints are located on each vertebra, on either side of the spine. These joints provide flexibility that allows patients to bend and move their spine. When these joints are damaged patients can experience pain. An injection of local anesthetic and anti-inflammatory steroids into a damaged facet joint can be used to diagnose and treat facet joint pain. As a treatment, facet joint injection focuses on reducing swelling and inflammation that can contribute to pain.

Conditions
  • Arthritis
  • Traumatic injury
Treatment
  • A needle is inserted near the suspected nerves using x-ray guidance
  • A mixture of local anesthetic and anti-inflammatory steroids are injected
  • Reduced inflammation can relieve pain
  • Pain relief can be long-term or temporary as the injury heals
Branch Nerve Injection
Injections into the branch nerves are used to treat inflammation in the small nerves that originate in the facet joints and feed out into the spine. These nerves can become damaged and swell, causing pain and discomfort. Injections of local anesthetic can reduce pain.

Conditions
  • Arthritis
  • Traumatic injury
Treatment
  • A needle is inserted near the suspected nerves using x-ray guidance
  • Dye is injected to provide contrast that can confirm that the presence of the medication
  • Local anesthetic is then injected into each branch nerve of interest
  • The anesthetic provides relief for pain associated with inflammation and swelling
  • Relief can be long-term or temporary as the injury heals
Epidural Adhesiolysis
This treatment is used to eliminate scar tissue that develops in the epidural space, the space directly outside of the membrane that encloses the spine. Nerves run through the epidural space and can become inflamed by rubbing against other tissues.

Conditions
  • Arthritis
  • Traumatic injury
  • Lumber spine surgery
Treatment
  • A needle is inserted into the epidural space to administer a local anesthetic
  • A catheter is then inserted into the epidural space
  • Anti-inflammatory steroids are then inserted through the catheter
  • Manipulation of the catheter is used to disrupt adhesions and scar tissue
  • Reduced inflammation and scar tissue relieves pain
Sacroiliac Joint Steroid Injection
An injection into the sacroiliac joint, a large joint in the lower back, can be used to relieve pain in the lumber spine and thigh. Inflammation in the joint can cause the tissue to rub together causing pain and discomfort. A steroid injection can reduce this swelling and irritation.

Conditions
  • Arthritis
  • Traumatic injury
Treatment
  • A needle is inserted into the joint using x-ray guidance
  • Dye is injected to provide contrast that can help identify the injured tissue
  • Steroids and a local anesthetic are then injected into the joint
  • The steroids provide relief for pain associated with inflammation and swelling
  • Relief can be long-term or temporary as the injury heals
Stellate Ganglion Block
This treatment blocks the signaling of the sympathetic nerve to reduce pain in a patient's arms. An anesthetic is injected into the sympathetic nervous tissue located in the cervical spine (neck) on either side of a patient's voice box. This can provide temporary relief from pain symptoms while the anesthetic is active.

Conditions
  • Shingles
  • Postherpetic neuralgia
  • Local nerve pain
  • Traumatic injury
Treatment
  • A small needle is inserted into the cervical spine using x-ray guided fluoroscopy
  • An anesthetic is administered through the injection
  • The anesthetic will numb the area providing relief from pain
  • Duration of relief will vary, and may be assessed over the first 3-4 hours
Lumbar Sympathetic Block
This treatment blocks the signaling of the sympathetic nerves in the lower back to relieve pain in the back and legs. The sympathetic nerves run along the outer surface of the spinal column, instead of within the spinal canal itself. These nerves control blood flow and regulate body temperature in the extremities. When these nerves are irritated it can cause pain in the back and legs that can be blocked with an anesthetic.

Conditions
  • Reflex sympathetic dystrophy
  • Local nerve pain
  • Traumatic injury
Treatment
  • A small needle is inserted into the lumbar spine using x-ray guided fluoroscopy
  • A contrast dye will be injected to confirm which nerves are affected by the treatment
  • An anesthetic will then be administered through an injection
  • Duration of relief will vary, and may be assessed over the first 20-30 minutes